Background During the last decade, the CHA(2)DS(2)-VASc score has been associated with adverse clinical outcomes in several cardiovascular (CV) and non-cardiovascular diseases beyond atrial fibrillation (AF). Whether the CHA(2)DS(2)-VASc score stratifies mortality risk in elderly patients with AF and without AF is not well established. Methods All consecutive patients aged >= 75 yrs hospitalized due to heart failure (HF), between January 2020 and November 2020, were retrospectively enrolled. All patients underwent physical examination, blood tests, electrocardiography and conventional transthoracic echocardiography. Primary endpoint was all-cause mortality, while secondary endpoint was the composite of all-cause mortality + rehospitalizations for all causes over mid-term follow-up. Results The study included 261 HF patients (86.3 +/- 6.4 years, 60.5% females). 85 AF and 176 non-AF patients were separately analyzed. Compared to non-AF patients, those with AF had significantly higher CHA(2)DS(2)-VASc score (5.6 +/- 1.4 vs 5.1 +/- 1.4, p = 0.007) and lower ejection fraction (47.4 +/- 16.5 vs 56.7 +/- 15.1%, p < 0.001). Mean follow-up was 1.7 +/- 0.5 yrs. During follow-up, 96 patients died (58.3% due to CV causes) and 79 were rehospitalized (58.2% due to CV causes). CHA(2)DS(2)-VASc score was independently associated with all-cause mortality in whole study population (HR 1.61, 95% CI 1.36-1.92) and in both AF (HR 1.41, 95% CI 1.09-1.82) and non-AF patients (HR 1.84, 95% CI 1.40-2.40). CHA(2)DS(2)-VASc score also predicted the secondary endpoint in the same study groups. CHA(2)DS(2)-VASc score >= 5 was the best cut-off value for predicting both outcomes. Conclusion At mid-term follow-up, a CHA(2)DS(2)-VASc score >= 5 predicts increased risk of all-cause mortality and re-hospitalizations for all causes in elderly HF patients, regardless of AF.

CHA₂DS₂-VASc score stratifies mortality risk in heart failure patients aged 75 years and older with and without atrial fibrillation [CHA(2)DS(2)-VASc score stratifies mortality risk in heart failure patients aged 75 years and older with and without atrial fibrillation] / A. Sonaglioni, C. Lonati, E. Rigamonti, M. Viganò, G.L. Nicolosi, M. Proietti, M. Lombardo, S. Harari. - In: AGING CLINICAL AND EXPERIMENTAL RESEARCH. - ISSN 1594-0667. - 34:7(2022 Jul), pp. 1707-1720. [10.1007/s40520-022-02107-x]

CHA₂DS₂-VASc score stratifies mortality risk in heart failure patients aged 75 years and older with and without atrial fibrillation [CHA(2)DS(2)-VASc score stratifies mortality risk in heart failure patients aged 75 years and older with and without atrial fibrillation]

C. Lonati
Secondo
;
M. Proietti;M. Lombardo
Penultimo
;
S. Harari
Ultimo
2022

Abstract

Background During the last decade, the CHA(2)DS(2)-VASc score has been associated with adverse clinical outcomes in several cardiovascular (CV) and non-cardiovascular diseases beyond atrial fibrillation (AF). Whether the CHA(2)DS(2)-VASc score stratifies mortality risk in elderly patients with AF and without AF is not well established. Methods All consecutive patients aged >= 75 yrs hospitalized due to heart failure (HF), between January 2020 and November 2020, were retrospectively enrolled. All patients underwent physical examination, blood tests, electrocardiography and conventional transthoracic echocardiography. Primary endpoint was all-cause mortality, while secondary endpoint was the composite of all-cause mortality + rehospitalizations for all causes over mid-term follow-up. Results The study included 261 HF patients (86.3 +/- 6.4 years, 60.5% females). 85 AF and 176 non-AF patients were separately analyzed. Compared to non-AF patients, those with AF had significantly higher CHA(2)DS(2)-VASc score (5.6 +/- 1.4 vs 5.1 +/- 1.4, p = 0.007) and lower ejection fraction (47.4 +/- 16.5 vs 56.7 +/- 15.1%, p < 0.001). Mean follow-up was 1.7 +/- 0.5 yrs. During follow-up, 96 patients died (58.3% due to CV causes) and 79 were rehospitalized (58.2% due to CV causes). CHA(2)DS(2)-VASc score was independently associated with all-cause mortality in whole study population (HR 1.61, 95% CI 1.36-1.92) and in both AF (HR 1.41, 95% CI 1.09-1.82) and non-AF patients (HR 1.84, 95% CI 1.40-2.40). CHA(2)DS(2)-VASc score also predicted the secondary endpoint in the same study groups. CHA(2)DS(2)-VASc score >= 5 was the best cut-off value for predicting both outcomes. Conclusion At mid-term follow-up, a CHA(2)DS(2)-VASc score >= 5 predicts increased risk of all-cause mortality and re-hospitalizations for all causes in elderly HF patients, regardless of AF.
Atrial fibrillation; CHA2DS2-VASc score; Elderly; Heart failure; Mortality;
Settore MED/10 - Malattie dell'Apparato Respiratorio
lug-2022
16-mar-2022
Article (author)
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2434/952888
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